Summary of findings 4. TCAs compared to SSRI for adults with panic disorder.
| TCAs compared to SSRI for adults with panic disorder | ||||||
| Patient or population: adults with panic disorder Settings: outpatient Intervention: TCA Comparison: SSRI | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| SSRI | TCA | |||||
| failure to respond Follow‐up: 8‐12 weeks | 378 per 1000 | 409 per 1000 (269 to 628) | RR 1.08 (0.71 to 1.66) | 438 (4 studies) | ⊕⊕⊝⊝ low1,2 | |
| total number of dropouts Follow‐up: 8‐24 weeks | 243 per 1000 | 238 per 1000 (158 to 359) | RR 0.98 (0.65 to 1.48) | 928 (7 studies) | ⊕⊕⊝⊝ low2,3 | |
| failure to remit Follow‐up: 8‐24 weeks | 502 per 1000 | 447 per 1000 (316 to 633) | RR 0.89 (0.63 to 1.26) | 475 (5 studies) | ⊕⊕⊕⊝ moderate4 | |
| panic symptoms Follow‐up: 8‐10 weeks | The mean panic symptoms in the intervention groups was 0.20 lower (0.88 lower to 0.48 higher) | 243 (4 studies) | ⊕⊝⊝⊝ very low5,6,7 | |||
| number of dropouts due to adverse effects Follow‐up: 8‐24 weeks | 104 per 1000 | 148 per 1000 (85 to 257) | RR 1.43 (0.82 to 2.48) | 476 (5 studies) | ⊕⊕⊝⊝ low5,8 | |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 Downgraded one point due to moderate heterogeneity (I squared = 61%) 2 Downgraded one point due to imprecision: 95% CI ranges from appreciable benefit with TCAs to appreciable benefit with SSRIs 3 Downgraded one point due to moderate heterogeneity (I squared = 47%) 4 Downgraded one point due to moderate heterogeneity (I squared = 58%) 5 Downgraded one point due to imprecision: dropout rate in one of the included studies (Nair 1996) is 48% 6 Downgraded one point due to moderate heterogeneity (I squared = 46%) 7 Downgraded one point due to imprecision: 95% CI ranges from appreciable benefit with TCAs to no difference 8 Downgraded one point due to imprecision: 95% CI ranges from no difference to appreciable superiority of SSRIs in lowering the number of dropouts